New HIV jab sparks demand in South African clinics

The new six-monthly HIV jab, lenacapavir (LEN), has sparked interest since its rollout in South Africa on June 5. At Phumlani Clinic in Cape Town, patients are asking for it by name, surprising even the clinic’s doctors.

Obtaining LEN isn’t as straightforward as receiving a single shot. It involves a multi-step process starting with an HIV test and including four tablets and two injections. Here’s what you need to know.

Your first visit: What to expect

At Phumlani Clinic, you can book online or walk in. While booking saves time, walk-ins are welcome. Reception staff will ask for your details — an ID or passport is helpful but not mandatory. The goal is to complete your visit within 90 minutes to two hours.

Before any injections, a nurse will discuss your HIV prevention options. LEN is one choice, but it doesn’t protect against pregnancy or other sexually transmitted infections. Condoms remain essential for those concerns.

Next, you’ll take an HIV test. If you test negative, you’ll proceed with LEN. If positive, clinic staff will help you start HIV treatment immediately.

On Day 1, you’ll take two LEN tablets and receive two injections in your abdomen or buttocks. These injections release LEN into your body over six months. After the shots, you’ll wait 10–15 minutes for monitoring. Minor pain or swelling at the injection sites is normal.

The next day, you’ll take two more tablets to ensure sufficient LEN is in your system. By Day 3, you should be protected against HIV, though it’s advisable to use condoms or other methods until then.

Follow-ups and reminders

About a month later, you’ll return for a check-up. Staff will assess any injection-site issues and perform another HIV test. If all is well, you’ll wait until your six-month mark for the next round of injections.

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Unlike the first visit, the six-month follow-up involves no tablets — unless you’re more than two weeks late. You’ll have another HIV test, and if you’re still negative, you’ll receive two more injections. The clinic will send an SMS reminder, but setting your own alert is advisable.

If you’re traveling or moving, inform the clinic. In the Western Cape, you can collect your injections from another clinic using the same electronic patient record system. Other provinces have similar systems for LEN data.

Side Effects and Monitoring

After receiving the injections, patients may experience minor side effects such as pain, swelling, or small bumps at the injection sites. These bumps are normal and act as depots for the slow release of LEN into the body over six months.

Patients should monitor the injection sites for any unusual symptoms, such as fluid leakage, rash, blistering, or changes in skin color. If any concerning symptoms arise, they should return to the clinic for further evaluation.

Long-Term Routine and Accessibility

For those who miss their appointment window, the process reverts to the initial steps, including the need for tablets. The electronic patient record system in the Western Cape allows patients to access their injections at different clinics, ensuring continuity of care even if they are traveling or relocating. Other provinces have similar systems for LEN data management.

The LEN Process: Tablets, Injections, and Follow-Ups

The LEN regimen begins with an HIV test. If negative, patients proceed with two tablets on Day 1, followed by two injections into the fatty layer under the skin. These injections, administered in the abdomen or buttocks, release LEN over six months.

On Day 2, patients take two more tablets to ensure sufficient LEN levels in the body. By Day 3, protection against HIV is expected, though condoms or other methods are advised until then. Follow-up injections are scheduled every six months, with a two-week grace period for early or late appointments. If patients return within this window, only injections are needed; if late, tablets are required again. The process repeats every six months, with HIV testing at each visit to ensure continued eligibility.